Objective To evaluate efficacy and safety of hormone combined mycophenolate mofetil (MMF) and tacrolimus (FK506) multiple targets treatment ,hormone combined intravenous cyclophosphamide pulse (IVC ) in the induction treatment of lupus nephritis .Methods The RCTs of MMF plus FK506 versus IVC in LN were searched from PubMed ,EMbase ,the Cochrane , CBM ,and CNKI .The literature were screened according to include and exclude standards ,evaluated the quality of the included stud-ies ,and performed meta-analyses using Revman 5 .1 software .Results It was identified 44 domestic RCTs papers including 331 pa-tients .Meta-analysis showed that multiple target therapy group had significantly superiority to IVC group in the induction treatment of Ⅴ + Ⅳ LN (RR=3 .94 ,95% CI 2 .10-7 .38 ,P<0 .01) ,while with no significant advantage for other pathological types of LN patients .Gastrointestinal reaction ,abnormal liver function ,the incidence of leukopenia ,menstrual disorders in multiple target thera-py group were significantly lower than that of IVC group for LN ,while the incidence of new hypertension group was significantly higher than the IVC group .Moreover ,multiple target therapy group could significantly reduce urine protein ,increase serum albumin and had a significantly higher anti-dsDNA negative conversion rate compared with IVC group .Conclusion Multiple target therapy is more effective than IVC for Ⅴ + Ⅳ LN in Chinese patients and with better security .Further large-scale RCTs are needed to con-firm these results .

Objective To discuss the effect of family nursing intervention on the life quality and pulmary function of patients with chronic obstructive pulmonary disease (COPD). Methods We divided 72 patients with COPD into the test group and the control group with 36 cases in each group.The two groups received routine treatment and nursing but additional family intervention was given to the patients and fam-ily members in the test group.The life quality and pulmonary function after intervention in the two groups were appraised in the two groups. Results The evaluation of life quality and pulmonary function were alleviated after intervention compared with those before intervention (P ＜ 0.05).But the above items in the control group were not significantly improved (P ＞ 0.05). Conclusions Effective family intervention could improve the life quality and pulmonary function of patients with COPD.

A sensitive colorimetric method for the detection of copper ions (Cu2+) was developed based on the surface modification of silver/platinum nanoclusters (Ag/Pt NCs) and regulation of peroxidase-like activity. It was found that 3-mercaptopropionic acid (MPA) could inhibit the catalytic ability of Ag/Pt NCs; however, it lost the inhibition toward catalytic ability of Ag/Pt NCs after oxidized by oxygen through the catalysis of Cu2+. On the basis of this, a colorimetric method was developed for the detection of Cu2+ through measuring the colorimetric signal variation of the TMB-H2O2 reaction. This method exhibited high sensitivity and selectivity toward Cu2+ over a panel of other metal ions. The linear range was 10-100 nmol/L and the detection limit was 5.0 nmol/L (3σ). The above method was also applied to detect real water samples and spiked samples, and the results demonstrated that this method was simple with low cost.

From both doctors and patients′different perspectives , this paper analyses the causes of conflict of doctor-patient communication , and from the subjective and the objective , the history and reality , individual and social aspects of light on the restricting factors for good doctor -patient communication , and puts forward strengthe-ning the consciousness of active , rule execution , achieving full coverage , explore ways to standard mode , rich di-verse ways and other countermeasures .

Objective:To explore the efficacy of group cognitive-behavioral therapy (GCBT) to generalized anxiety disorder (GAD).Methods:In this randomized controlled trial,the control group (n =23) and the intervention group (n =33) were included,all of the participants received duloxetine (30-120 mg/d) as pharmacotherapy.The intervention group received 8 group cognitive-behavioral therapy sessions weekly,90 minutes for each time.Assessments were conducted with the Hamilton Anxiety Scale (HAMA),Hamilton Depression Scale (HMAD) and Clinical Global Impression (CGI) at baseline,mid-treatmentand post-treatment.CGI included three factors,the severity of illness (SI),the globalimprovement (GI) and the efficacy index (EI).Results:The repeated measures analysis of variance of HAMA showed that,there were statistical significance on the HAMA for interaction between measure time and group processing (F =4.35,P ＜ 0.05).Compared with the control group,the intervention group got higher decreased scores of HAMA at the 4th week and 8th week,and higher prevalence of being cured and efficient at the 4th week.At the 8th week,the decreased scores of HMAD were higher in the intervention group than in the control group,and the scores of CGI-SI and the CGI-IE were lower in the intervention group.Conclusion:It suggests that group cognitive-behavioral therapy combined with pharmacotherapy could be earlier to be effective,and the symptoms of anxiety,depression and the state of illness could be improved more significantly compared with pharmacotherapy alone.

Objective:To assess the validity and reliability of the depression and somatic symptoms scale among patients with coronary heart disease.Methods:Totally 246 patients with coronary heart disease were assessed with depression and somatic symptoms scale (DSSS), Hamilton depression rating scale for depression (HAMD) and patients’ health questionnaire depression scale-9 item (PHQ-9). The structural validity was evaluated with exploratory factor analysis and confirmatory factor analysis. The validity as a screening tool was evaluated with the gold standard diagnosed by psychiatrists who were trained with the mini international neuropsychological interview (MINI) according to ICD-10. Receiver operating characteristic (ROC) curve was used to identify cutoff scores for depression. Cronbach α coefficient was used to evaluate the internal consistency.Results:Exploratory factor analysis yielded two factors: depression factor and somatic factor, and the cumulative variance was 51.8%. The fitting indexes of confirmatory factor analysis were as follows: χ2/ df=3.636, RMR=0.077, RMSEA=0.104, IFI=0.804, TLI=0.781, CFI=0.802. The intraclass correlation coefficient of DSSS and HAMD was 0.54. The area under ROC curve (AUC) was 0.828, and the best boundary value was 17 points (sensitivity and specificity: 81% and 75%, respectively). The total scores and subscale scores for internal consistency of DSSS were higher in the depression group than those in the non-depression group ( P<0.01). Cronbach α coefficient for internal consistency of DSSS was 0.917. Conclusion:The DSSS has good validity and reliability among patients with coronary heart disease for screening depression, and can be used to screen depression among patients with coronary heart disease in general hospital.

Objective To detect the expressions of intercellular adhesion molecule-1(ICAM-1)and nu-clear factor(NF)-κB in hepatic tissues of the patients with chronic hepatitis B,and to analyze their correlation with the hepatic inflammatory activity and fibrosis degree.Methods The liver biopsy specimens from 66 pa-tients with hepatitis B and 10 non-hepatopathic controls were selected,and immunohistochemistry and in situ hybridization were used to detect ICAM-1 and NF-κB expression levels in different liver tissues.Results The positive rate of ICAM-1 and NF-κB expression in liver tissues of the patients with chronic hepatitis B was higher than that in normal liver tissues,and the difference was statistically significant(P＜0.05).The expres-sion of ICAM-1 and NF-κB in the patients with hepatitis B was positively correlated with the inflammatory ac-tivity and fibrosis degree(r=0.493,0.496,P＜0.01;r=0.580,0.519,P＜0.01).Conclusion ICAM-1 and NF-κB in the patients with chronic hepatitis B are highly expressed,which is useful in judging the hepatic in-flammatory activity and fibrosis degree.

OBJECTIVETo observe the clinical characteristics of infections in adult acute leukemia （AL）patients during chemotherapy in hospital, and identify the risk factors for infections.

METHODSA retrospective study of patients with AL who underwent chemotherapy between July 2010 and Dec 2014 in the First Affiliated Hospital of Xiamen University was conducted. Clinical features and risk factors for infections were analyzed.

RESULTS191 patients with AL received a total of 728 courses of chemotherapies. During these admissions, 385（52.9%) infections episodes occurred. The common infections sites were lower respiratory tract infection（36.3%，153/374）, bloodstream infection（17.1%, 64/374）, oral infection（13.6%，51/374）, and perianal infection（13.4%, 50/374）. 164 strains of pathogenic bacteria were detected. Gram- negative bacteria were recorded in 59.1% of documented pathogens, and Gram- positive bacteria were responsible for 32.9% of infections. Multivariate unconditioned logistic analysis of factors identified consistent independent risk factors for no completely remission（OR=0.142, P< 0.001）, duration of neutropenia longer than 7 days（OR=12.764, P<0.001）, general wards（OR=1.821, P< 0.001）, and hospitalization interval longer than 10 days（OR=0.720, P=0.039）.

CONCLUSIONInfections after chemotherapy for AL continues to be common. AL patients with induction chemotherapy or severe neutropenia faced an increased risk of infections by multivariate analysis. And patients with short-term stay or laminar flow wards seem to be less susceptible to infections.

Acute Disease ; Bacterial Infections ; complications ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Hospitals ; Humans ; Leukemia ; complications ; drug therapy ; microbiology ; Multivariate Analysis ; Neutropenia ; complications ; Remission Induction ; Retrospective Studies ; Risk Factors

Objective:To evaluate the effects of the cassette 14C-urea breath test kit, scintillation sampling bottle (solid-state scintillation method) and liquid scintillation 14C-urea breath test kit in the diagnosis of Helicobacter pylori ( H. pylori) infection. Methods:From January 7 to October 28, 2020, 239 patients were enrolled who visited Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine and the First Affiliated Hospital of Nanchang University. All subjects first received 14C-urea breath test.Within >1 to <7 days after gas collection, mucosal tissues were taken under gastroscopy for gold standard test, including biopsy and rapid urease test (RUT). If both biopsy and RUT indicated H. pylori positive, the result of gold standard test was H. pylori positive, and if both were negative, the result of gold standard test was H. pylori negative. If the results of biopsy and RUT were inconsistent, they were not included in the subsequent analysis. Based on the results of gold standard test, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the cassette 14C-urea breath test kit, scintillation sampling bottle, and liquid scintillation 14C-urea breath test kit in the diagnosis of H. pylori infection were analyzed. The safety of the test was evaluated by whether there were any adverse events during the test. Descriptive methods were used for statistical analysis. Results:Among the 239 subjects, 12 cases did not complete the test, 227 subjects finally completed the test. The test completion rate was 95.0% (227/239). No.008 patient was only included in the analysis of cassette 14C-urea breath test kit and scintillation sampling bottle because of lacking the result of liquid scintillation breath test. The results of gold standard test showed that among 227 patients, 87 cases were H. pylori positive, 118 cases were H. pylori negative. The results of biopsy and RUT were inconsistent in 22 cases, so they were not included in the subsequent analysis. Excluding No.008 patient, the results of gold standard test showed that 86 cases were H. pylori positive and 118 cases were negative. Based on the results of gold standard test, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of cassette 14C-urea breath test kit, scintillation sampling bottle, and the liquid scintillation 14C-urea breath test kit in the diagnosis of H. pylori infection were 91.9%, 100.0%, 96.6%, 100.0% and 94.4%, respectively; 95.4%, 97.5%, 96.6%, 96.5% and 96.6%, respectively; and 96.5%, 99.2%, 98.0%, 98.8% and 97.5%, respectively. Only one adverse event (right upper abdominal pain after eating) occurred. Combined with the patients condition, the adverse event was determined as the onset of chronic cholecystitis and it might not be related to the test medication. Conclusions:Cassette 14C-urea breath test kit, scintillation sampling bottle, and liquid scintillation 14C-urea breath test kit have reliable performance, good safety, and high sensitivity, specificity and accuracy in the diagnosis of H. pylori infection, which are worthy of clinical application.

Objective: To understand prevalence and trend of drinking behavior among middle school students in Quzhou during 2012 to 2022, and to provide a basis for formulating scientific and effective intervention measures for adolescent drinking. Methods: By using stratified cluster sampling method, a questionnaire survey using Zhejiang adolescent health related behavior questionnaire was conducted anonymously in selected classes in May 2012, 2017 and 2022, respectively. Changes of drinking behavior of middle school students in different years were analyzed. Results: The prevalence of ever drinking, current drinking and drunkenness among middle school students in Quzhou decreased from 58.05%, 22.70% and 21.25% in 2012 to 41.83%, 15.35% and 11.54% in 2022, respectively ( χ 2 trend =82.69, 30.00，58.24, P <0.01). In the past 30 days, 66.67% of students reported drinking 1-2 days, the proportion of drinking for 3-5 days increased from 16.36% in 2012 to 26.19% in 2022, the proportion of drinking for 6-19 days decreased from 13.03% in 2012 to 3.40% in 2022. The proportion of buying alcohol increased from 22.12% in 2012 to 35.03% in 2022. The results of the three surveys showed that, now drinking rates, drinking rates, Male students (27.88%，23.96%，18.75%；24.69%，17.44%，13.75%) was higher than the girls (17.60%，17.25%，11.31%；17.87%，10.61%，8.91%)， non ordinary high schools (33.96%，34.69%，22.77%；33.65%，23.91%，19.49%) were higher than ordinary high schools (25.82%，18.80%， 12.62 %；25.82%，17.35%，9.94%) and junior middle school (16.53%，15.83%，12.22%；13.93%，8.47%，7.35%). Conclusion Progress in adolescent drinking control is being made in Quzhou, with the prevalence of ever drinking, current drinking and drunkenness significantly decreased. It is necessary to strengthen the control of drinking behavior among middle school students from the aspects of school, family and society, especially for boys and students in non ordinary high school students.